DataLabs

datalabs.health made in the usa

Contact us Sign in | Documentation |

divider

Medicare/Medicaid Verification Programs divider

divider

Medicare Verification Program divider

divider

1518943943

NPI Code Detail

MEDICARE: DR. PHILLIP MABON WILLIFORD MD

MEDICARE: DR. PHILLIP MABON WILLIFORD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ND0101X	MOHS-Micrographic Surgery Physician	26483	NC
2	207NS0135X	Procedural Dermatology Physician	26483	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	70016802	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	88074	OTHER		BCBS
2	5552	OTHER		PARTNERS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	4671710	OTHER		AETNA
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	64002	OTHER		MEDCOST

General Provider Information

NPI Number	:	1518943943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILLIP MABON WILLIFORD MD

Provider Business Mailing Address
First Line	:	PO BOX 344
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27102-0344
Country	:	US
Telephone Number	:	336-716-2255
Fax Number	:	336-716-6761

Provider Business Practice Location Address
First Line	:	4618 COUNTRY CLUB RD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27104-3520
Country	:	US
Telephone Number	:	336-716-2255
Fax Number	:	336-716-6761

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	11/15/2010

Similar Medicare Providers

1437048162 — VICTORIA IFEDINMA UDOCHU PA-C
Practice Location Address:

4618 COUNTRY CLUB RD
WINSTON SALEM, NC
27104-3520

Practice Phone: 336-716-3926
Practice Fax: 336-716-9258

1013932565 — DR. TEMPLE V DAY M.D.
Practice Location Address:

4614 COUNTRY CLUB RD
WINSTON SALEM, NC
27104-3520

Practice Phone: 336-716-5122
Practice Fax: 336-713-0976

1720063175 — STEVEN RICHARD FELDMAN MD
Practice Location Address:

4618 COUNTRY CLUB RD
WINSTON SALEM, NC
27104-3520

Practice Phone: 336-716-3926
Practice Fax: 336-716-9258

1063497196 — DEBRA COPELAND SIZEMORE PAC
Practice Location Address:

4618 COUNTRY CLUB RD
WINSTON SALEM, NC
27104-3520

Practice Phone: 336-716-2255
Practice Fax: 336-716-9258

1255316311 — RITA OTILIA PICHARDO MD
Practice Location Address:

4618 COUNTRY CLUB RD
WINSTON SALEM, NC
27104-3520

Practice Phone: 336-716-2255
Practice Fax: 336-716-9258

1134104177 — AMY JO MCMICHAEL MD
Practice Location Address:

4618 COUNTRY CLUB RD
WINSTON SALEM, NC
27104-3520

Practice Phone: 336-716-2255
Practice Fax: 336-716-9258

Directions to “ DR. PHILLIP MABON WILLIFORD MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.